| NPI | 1780633131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NJ 25MA06041500) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA060415) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2025-01-24 |